FORM 3

[See Rule 3(a) and 13]

LEARNER'S LICENCE
Fee Details Rs.380.0/- /TNS/3240780 /30-10-
2019
1. Licence No. TN12 /0014474/2019

2. Name JAGADISH KUMAR

3. Father's Name DORAIPANDIAN

4. Date of Birth 23-01-1973

Optional/Blood Group-
5. RH Factor O-

A 103 JASMINE COURT MOUNT

6. Present Address POONAMALLEE ROAD KATTUPAKKAM Holder's Signature
CHENNAI,600056

A 103 JASMINE COURT MOUNT

7. Permanent POONAMALLEE ROAD KATTUPAKKAM
CHENNAI,600056

8. Marks of Identification (1) MOLE ON RIGHT SHOULDER

(2)

is licenced to drive throughout India as a learner subject to the provisions of rule 3 of the Central
Motor Vehicles Rules 1989, a motor vehicle of the following description
LMV, MCWG,
.......................................................................................................................................

*The holder of the licence has passed the preliminary test referred to in rule 11(1) of the CMV
Rules ,1989.
*The holder of the licence has exempted the medical test under rule 6 and from the Preliminary
test under rule11(2)of the Central Motor Vehicle Rules,1989

*Strike off which ever is inapplicable

This Licence is valid from 05/11/2019 To 04/05/2020

Assistant Licensing Authority

Warning:
RTO, POONAMALEE,
The attention of the holder of this licence is drawn to rule 3 of CMV Rules, 1989 which prohibits him
from driving any motor vehicle unless he has besides him a person duly licenced to drive the vehicle
and in every case , the vehicle carries "L" plates both in front and in the rear of the vehicle.